Walking Through the Long-Term Care MassHealth Application for an Unmarried Person

The MassHealth application is an intimidating document that takes into consideration many aspects of the applicants situation. It can be a daunting task to fill out and submit the application without a thorough understanding of what MassHealth is looking for from the applicant.

Join us for some insight into how the MassHealth application should be approached for an unmarried individual. We will be joined by our guest speaker, Attorney Elaine Breslow, and we will walk through the MassHealth application to highlight the important parts,

Some of the issues that will be discussed in this webinar include:

– What is the five-year financial look-back period?

– What sections of the long-term care application are applicable to an unmarried person?

The opinions expressed in this webinar are the opinions of Attorney Brian Barreira and Attorney Elaine Breslow on the law as written as of the date of the webinar recording, December 16, 2021. The information presented in the webinar is for informational purposes only, and is not a substitute for individualized legal advice.

Webinar Transcript

Brian: We’re going to get started with this webinar which is about the MassHealth long-term care application for a single person. We’re not doing married people this time. With me is Elaine Breslow who’s a member of the Connecticut Bar and she assists our office with MassHealth applications. Hello.

Elaine: Hi, nice to be here today.

Brian: Okay, so we’re not gonna deal with married people today and we’re going to come back and do that some other time, there’s a whole layer of complexity with MassHealth applications for married people but just about everything we’re going to go over for a single person would also apply to the married application it’s just that it’s more complicated for married people. So, to start out with, ‘what is MassHealth?’ MassHealth is the government program that helps people pay for nursing home care. I mean there are other parts to MassHealth but we’re primarily focusing today on the long-term care nursing home benefit. In order to apply for this benefit you have to get an application. I mean the applications are out there, they’re online, the state website has it, there are lots of nursing homes have copies and we have a website masshealthapplication.com that has a current copy of it along with other forms that are also needed along the way. So how do you how do you apply? You fill out the form. There are basic pieces of information that have to go along with it and you either mail it or you fax it to a center. What happens there? It goes to Charlestown then they distribute it across the state, there are four centers around the state that deal with MassHealth, so you could be somebody who lives on Provincetown and your application could be handled in Springfield, they just randomly assign it to try to even the workload around the state. When you file you are causing yourself some stress because you’re triggering a 45 day clock. The MassHealth agency has to get the application in and out within 45 days. So when you file, you’re creating the clock that’s going to start running, so sometimes it’s better to wait make sure you’ve got everything together, even waiting a few days to gather everything and then file. We’ll deal with that more later but
if you don’t get everything in, now the MassHealth lawyers will tell us in court and outside of court that the computers are not set up to automatically deny people, but all the case workers who deal with MassHealth, all the people we’re actually dealing with the application with us tell us that the computer is set up to spit out a denial unless they do something to approve the case within the 45 day period. So that’s basically what happens with MassHealth. In some states you have to apply in this month to get any part of this month covered. In Massachusetts we can go back three months retroactive. So, if we applied any time during December the application could be effective back all the way to September 1. So that’s one of the reasons I was saying sometimes it’s best not to rush and make sure you get everything together. So we’re gonna turn this over to Elaine now to start talking about the basics of the application.

Elaine: So I believe on your screen you should be seeing the actual application for seniors and people needing long-term care services and Brian mentioned that if you could just look at that left hand envelope, these days we are told to mail the MassHealth application to this Charlestown address and as Brian mentioned, it actually gets scanned and then it gets sent out and distributed to various different MassHealth enrollment center locations. So rather than, we used to mail it to a specific location where we started developing relationships with caseworkers who were easier to get on the phone and ask a question about something, these days we’ve been advised to actually send it directly, if you are mailing it, to the Charlestown application center where it will be scanned as I said. Okay so we can scroll down a little bit and there are many many different things and items that you’ll see on the application if we go to the first page that are required and just like a scavenger hunt where there’s a very specific list of things in order for you to get points toward your winning goal for the scavenger hunt, the MassHealth application is similar in that when they ask for something you need to provide that verification and documentation and not some variation of that item or documentation. So, in other words if you see something listed here other than some basic things like your name and your address etc., you will every time you see something in essence you are going to be required to provide a piece of paper to document and verify that what you are stating is in fact true. It’s not enough to submit when we get to the bank accounts and assets to just say, ‘oh you know I spent this money to buy groceries for my parent’, you have to show receipts and things like that. So if we can scroll down a little bit further, so this first page typically when we are a single person applying for long-term care services, for example that person is or is about to be in a nursing home, you’re going to be checking off this long-term care box. And we go down to step one, and here very you know general information first name, last name, addresses and is the person, is this address, is it a person that isn’t currently in a nursing home and then you provide that information as well because there will be things that the nursing home will have to provide to MassHealth, these are other long-term care verifications that will come directly from the nursing home and other entities. So, we can skip down to step two. So step two, again is just providing information about yourself very straightforward in case you don’t know that person one is you the relationship number three tells you that it’s yourself. Which may be the obvious but nothing is obvious with MassHealth. Then again we can scroll down further, again we are speaking about a single person at this point either because they’re widowed or they are still in fact never married then the obvious question under A would be no and then you would just skip down to number seven. Which I don’t even see here, okay and then the questions are if you are a naturalized citizen, if you’re a U.S. citizen there’s several questions and you know since 9/11 these questions seem to populate these applications as they update them more and more frequently. If you’re a non-citizen you have to provide other documentation. Do you live in Massachusetts down in number 10? Number 11 is at least asking you about, and again this is the question that goes to if you’re living with a child that is you know younger than age 19 then there may be several implications to that which gets a little bit confusing and we can talk about that a little bit later. We can continue going down to ‘do you rent or own your own property’ and that again has different implications depending on the answers to that. These next questions tend to be whether you are looking to be or are in a nursing home due to an accident or a disability, so on and so forth. So, income information this next section number 19, income at this point we’ll be asking, and most people will have let’s say social security benefits at this point they may have a pension, there may be other type of income I would suspect in most cases for a single person finding themselves in this a situation of needing long-term care it’s not likely that they’re still working or employed so those questions you know, those are not applicable. So again, if we go to 25 those are some examples of if you receive any of this type of income. Now it’s not just enough to say ‘yes I get a retirement pension and I get a hundred dollars monthly’ at that point it triggers you having to provide a letter documentation from the institution that you receive your pension from to substantiate what that amount is and how often. Some people will say, ‘oh but it’s on my bank statement because I get direct deposit’, well that may in fact be so but for MassHealth purposes they will still ask you for a copy of the pension letter or the monthly or quarterly, however often you receive your pension benefits, they want something to substantiate what that number is and how often you receive it. The same with any of these other things, social security they typically- at the top you’ll see this, it’s not new-new but you don’t have to tell – you tell them about supplemental social security income but if you have your yearly social security benefit statement, which usually kicks in around the end of well January end of December, providing that letter is often helpful. Rental income, again some people may have a home or a second home that they are renting out, they want to know all that. That goes to you know again eligibility issues one-time income are there things like that that you received you know a one-time payment, did you win the lottery last year, did you know come into some huge inheritance? Then deductions, again these are very straightforward any of these things that you would report or or claim on your your tax returns. Again, it seems like this this application which I believe is the most current one the date on it is on 7/21. So what you’ll notice is they’re actually asking you about unemployment income in 2021 because there were a lot of benefits and obviously MassHealth wants to understand and take that into the big picture. And while I’m talking about the date of the application it is really important to get your hands on the most current one, we haven’t seen this a lot but MassHealth could say, ‘well this just out of hand, you know, deny it because it’s not a current application’ so it’s – you’re safer if you can try to get your hands on what the most recent ones are and Brian did mention where you can actually get the application. So we’re going to skip step two completely because in this case as we mentioned we’re going to be talking about a single person so none of that is applicable. Step three there are again questions about you know being an American Indian or Native person so you answer accordingly. Step four, do you have medical services that you got three months before we got your application? So again, that’s because in Massachusetts it will be retroactive, can be retroactive for three months so do you want to apply for MassHealth, I believe we always say just yes, why not, nothing lost. Okay, so step five.

Brian: Let me just jump in here and just mention something about this. This is really an important spot because if you get a denial and then don’t appeal it, you’re going to make sure that you have the right date, the effective date for MassHealth, so when you reapply you always have to make sure that you’re working within the three-month period or else it’s better to appeal than reapply.

Elaine: That’s nuanced and maybe you want to circle back to that a little bit or do you want to expand?

Brian: Well I just just want to point out to people that this is the date. Now, when you- if you get a denial, they treat it as a new application if you submit something. It gets very tricky to make sure you get coverage and if you don’t get coverage then somebody might get sued by the nursing home. So, this section right here this step four previous medical bills is really an important point to a lot of people especially if they’re scrambling to put it all together toward the end. I’ll leave it, I’ll just leave it at that for now.

Elaine: Okay, and just what you just mentioned now is important to consider when you said don’t rush things. There is time to submit some further documentation at some point, which I will talk about a little bit later, and so it isn’t completely necessary to have every single piece of documentation in place when the application is first filed. Having said that, you are far better off getting in as much as possible because you also will be more likely than not receiving an information request from MassHealth to explain some of these things and then you have a better idea of what they’re looking for and what they no longer consider pertinent to your application. So step number five, this gets to be rather tedious and essentially most important. So bank accounts, a lot of times in today’s world people can access bank statements, pension statements, you know cd information, all sorts of things online. But oftentimes, a single person who may already be in the nursing home can’t do that and needs assistance from a relative or an agent, so it is always best advised to try to get these bank account statements as soon as possible and they are looking back five years so 60 months. And it is any account that this applicant has had their name on and may or may not have closed in the last five years And so they want to see that and as I say sometimes, if you have to request this from the banks it takes time, they don’t always give you the actual copies of the checks, which is also what if it’s any amount over fifteen hundred dollars typically MassHealth is questioning and looking at more closely and so that needs to be done sooner rather than later. For those people who still receive their statements in paper form. It’s always a great idea to just get a binder or something and just keep them in there, you know collect them up keep them in there so if somebody’s helping you with the application they have access sooner rather than later to that information.

They will also be, as I mentioned, anything that the applicant’s name is on currently, any account or anything that’s been closed within the last five years we need to provide those statements for those accounts even though they may be closed. Now oftentimes, they don’t give you enough space for all the accounts that somebody may have and so what typically is you can make copies of this sheet, this page on the application and just continue you know, just list it and number it or see next page so that the MassHealth caseworker knows that you’re providing additional information because on this application it basically allows you two accounts and that oftentimes we find that isn’t sufficient. The other thing that’s important is to try to show, if an account has been closed, try to show where that those funds went. So if they were you know transferred through the bank itself into another existing account, be able to show that and when it happened and how much it was that was transferred. They’re trying to create a paper trail so to speak of what you have and where it went, where it started and where it went.

Brian: Okay, so let me add, let me add something from the experience of another elder attorney in Massachusetts. Elaine was just saying, show where it went, a lawyer wrote a long letter explaining where all the money went from here to here to here to there, it was somebody was a cd shopper who bounced money around and got a denial; called the caseworker and said, ‘I explained it all in the letter’ and the caseworker said ‘oh, I don’t have time to read letters’. So write it right on the statement, don’t think that they’re going to read a letter and if you can write, write on the statement this got closed and went to this other account and then on the other account you write this was received from that other account. If you can provide the links there right on the statement it might be more helpful than writing a letter.

Elaine: Right, right.

Brian: So we’re in a strange world here where you write a letter and the person in charge of your application doesn’t read it but that’s what we’re stuck with.

Elaine: Right, and oftentimes you cannot even speak to that caseworker to ask the question, ‘what was it that was missing’ and ‘I can provide you with because I’m all too happy to’, – and clearly Covid has not helped, caseworkers were working remotely and they claimed when I finally got somebody on the phone that, oh they don’t even have access to the files, so it’s a brave new world out there but try to do your best and be as organized as possible. So real estate again we can go down to there that’s pretty straightforward. If in fact the person still has a legal interest in their primary residence, then you have to provide you know a copy of the deed, tax bills, if there’s in fact still like a mortgage out on that any, anything else any liens on the property. So that that is again a kind of pain in the neck documentation but that is required.

Brian: And if you have a life estate that’s a legal interest. So just because you deeded it away, if you kept any rights in the deed then you have to say yes to these questions.

Elaine: Right. Oftentimes, you can also – the current tax bill you know a lot of times a senior or somebody who’s you know not feeling well is not really going through the mail, not collecting things, not keeping things and so as far as like a current tax bill you can go into your town hall, the person’s town hall and request those kinds of records and they should very easily and quickly provide you with that. Okay next, life insurance again very straightforward, sometimes there is a cash surrender value for the life insurance and I’ll let Brian maybe talk about sometimes what should be done or needs to be done. Oftentimes this person may have just term insurance and then on the actual you know premium or the face letter it will state that and again you can highlight or circle the fact that there is no cash surrender value so that the case worker understands what type of life insurance this is. Again, we try to – they’re busy you know in all fairness, as frustrating as it is for an applicant or for me when I’m assisting an applicant or their family these case workers are jammed up and so they don’t have time to do that, so what we try to do is make the picture as clear and simple as possible so that they would have no reason you know to deny an application or less of a reason to request further information. Securities, brokerage accounts, stocks and bonds, again those are the kinds of things that – or anything that’s in a safe deposit box, you need to be you know forthright with that and provide information and documentation. Annuities the same thing, copy of the annuity you know has to be provided itself you know, who the owner is of the annuity, when it was purchased, so on and so forth and that information would be obviously on the annuities themselves. Anything else on that Brian because sometimes those –

Brian: We are quickly running out of time here.

Elaine: Okay, all right. So, was there any kind of deposit given to the to the nursing home or assisted living, and the nursing home can provide you with a receipt for that if you say yes. Vehicles, mobile homes again this is if and at this point it’s probably not likely that the applicant is still driving or has access or a mobile home. So then we skip down to pre-paid burial plans. These are, and again oftentimes people choose to do this because in a crisis moment this is something that you don’t have to think about, it’s something that’s permissible as a way to spend down a person’s assets and so the funeral home, you want it to be an irrevocable contract there needs to be certain things itemized and provided to MassHealth to substantiate all that. And so here just again, the funeral home, and they’re very familiar with MassHealth applications, they should be able to provide this information. And if this was done ahead of time then the applicant should have in their possession or you know with again a sibling or a child that person should be able to access that information already. Trusts, that’s a big topic.

Brian: We have largely beaten them back on most of their trust arguments. But, if you have a trust you really want some help with your application. I think we can just leave it at that because they can mess up they can really mess up with trusts. Okay.

Elaine: Okay, all right health insurance information again does this person have health insurance, what kind? You provide copies of the front and the back of your Medicare card and any other supplemental insurance that you may have that you know the applicant has and just go down the list of providing that information as best as possible. Again, they want to know is there some kind of benefit that you’re not claiming or you should be claiming and that goes toward the consideration of the entire application and eligibility. All right, let’s see. This is new, this health reimbursement arrangement.

Brian: Well this is essentially an Obamacare application too it’s not just for long-term care for nursing home care so that’s why it’s got so many other things in here. So that’s a health insurance related thing that we can skip, we can skip by that.

Elaine: Right, right exactly, and also we can skip eight because this person is presumably going into a long-term care facility.

Brian: And then step ten sign.

Elaine: And let’s just sign it. So make sure if we can scroll to the bottom, it depends on who’s signing and in what capacity. So there are other forms in addition to the application that if the applicant themselves needs help and needs somebody that you know also they would like to be able to speak to MassHealth on their behalf then there are two forms. One is called the PSI which is permission to share essentially which again if you’re working with a law firm then we would have the applicant fill one of those out or the applicant’s agent so that we could call MassHealth since we’re helping with the application and say well we don’t understand what this is or can you clarify this request. Without that form they cannot speak to us nor could they speak to the family member, so in addition to that there’s an authorized representative form as well and that should be filled out and there are three pages I believe to that form. Typically page three is the one that if you have durable power of attorney that’s typically the part, the section of the form that you’re filling out because it’s explaining how you were empowered to speak on behalf of this applicant and to file the application itself. So it may be, as we see signature person one or authorized representative or responsible party, so you can’t just say that let’s say ‘I am Jane Doe and I am an authorized representative’, I have to also submit the power of attorney form and also submit this authorized representative form so that they know that I am in fact authorized, legally authorized to file and submit this application.

Brian: Sometimes they’ll let someone claim to be responsible who has no real legal authority, then if there’s a mistake made and you have to appeal you can’t appeal because you need the authority to be able to appeal to it and you cannot appeal without a power of attorney or a conservatorship or if you’re the one who’s applying. So don’t get fooled here that just because they let you file an application that you can appeal. Well I think we’re almost out of time here so what else we’ve got?

Elaine: So again the last thing I want to say is in addition to this long-term care application, this lengthy application, you must also file supplement A. So, supplement A appears here and again a lot of it is redundant but you have to have this as well in addition to the application. So rather than – because I just said it’s somewhat redundant the only thing that they are asking for here that’s a little bit, well a few things but we don’t have a spouse so we don’t have to think about you know copies of those utility bills and things like that. Resource transfers, they very much are interested in this you know or have there been any gifts made and in what amounts and and to whom, so on and so forth. Did you give a deposit, real estate? Again this is a redundant, repetitive question. Let’s see further down. Okay, no spouse things like that. Long-term care insurance, Brian do you want to just mention something about if you say yes or no if you have –

Brian: I mean the questions here are do you have it and if you say yes then your home can be exempt, but if you also say I intend to return home then your home is not exempt. So, you’ve got to be careful here, this is where if you have long-term care insurance and you have a home you got to make sure you get these questions right. This is where people can mess up and lose their home needlessly so that’s when people really should get some help with this application. I mean I believe strongly in letting people do things on their own and I encourage a lot of my clients to do it on their own but that’s that’s a spot where you could really mess up. Then finally, since we’re right at the end here, tax returns. They asked for your last two years of tax returns. Now the look back period is five years, when the look back period was three years they were asking for two years they’ve never really updated that but they- part of the reasoning there is they look for the income that’s itemized on your income tax returns to make sure that you’ve reported those assets that gave you that income so that’s one of those cross checks they’re trying to catch you. Okay.

Elaine: All right and again make sure you sign it and date it and you send both of these forms in. Are we having fun yet?

Brian: All right so we’ll eventually come back and do the, go back through the application with the looking at it from the standpoint of a married person. And thank you Elaine.

Elaine: All right, pleasure, all right, thank you.

Brian: Thank you all for joining us.